Yoga Bests Usual Care for Back Function

Yoga has again proven superior to routine care for improving function in patients with chronic low back pain, researchers found.

Action Points

Explain that in the second study in as many weeks, yoga has again proven superior to routine care with respect to back function in patients with chronic or recurrent low back pain.

Note that the yoga group had no significant improvement in back pain or general health compared with usual care.

In the second study in as many weeks, yoga has again proven superior to routine care for improving function in patients with chronic low back pain, researchers found.

The stretching-and-mindfulness-based therapy improved back function in adult patients in the U.K. with the condition, more than usual care, Helen Tilbrook, MSc, of the University of York, and colleagues reported in the Annals of Internal Medicine.

"Yoga seems to be a safe and effective activity that clinicians could consider recommending for patients with a history of low back pain," they wrote.

Studies have shown that yoga could effectively treat back pain. In fact, just last week, a trial found that it boosted function compared with those on usual care. However, it was no better than plain stretching, without the mindfulness component, those researchers found.

But Tilbrook and colleagues theorized that mindfulness, as well as the discipline's emphasis on self-awareness and good posture, would offer additional benefits.

So they assessed 313 adult patients with chronic or recurrent low back pain, who were randomized to either yoga or usual care. Most were middle-aged employed women who'd been in pain for about 10 years.

All participants received a back pain educational booklet, and the intervention group received 12 classes of yoga, delivered by 12 teachers, over three months.

The primary outcome was disability score as measured by Roland-Morris Disability Questionnaire (RMDQ), with scores ranging from zero (best) to 24 (worst), at three, six, and 12 months. Secondary outcomes included pain and general health measures at those times.

The researchers found that the yoga group reported better back function at all time points compared with those on usual care group.

The adjusted mean RMDQ score was 2.17 points lower in yoga group at three months, 1.48 points lower at six months, and 1.57 points lower at one year, they reported.

The fact that the benefits diminished over time, after the classes finished, suggests that more classes may be required to maintain the improvements, the researchers said.

They added that the maintenance of long-term benefits may have been because of home practice, as 60% of patients reported that they continued to practice on their own even after classes ended.

In sensitivity analyses, however, under the worst-case-scenario analysis, there were no differences in back function between the yoga and usual care groups.

Nor were there any differences in back pain or general health scores at any time points, they found. However, those who practiced yoga did report higher pain self-efficacy at three and six months, although not at one year.

"Although there was no evidence of pain reduction at 12 months, confidence in performing normal activities despite pain improved more in the yoga group than usual care group at three and six months," they wrote.

Two of the 157 usual-care patients (1%) and 12 of the 156 yoga participants (8%) reported adverse events, mostly increased pain, the researchers reported. One instance of increased back pain was classified as serious and possibly related to yoga, they said.

The study was limited because there were some missing data for the primary outcome, and some differential missing data for secondary outcomes.

Still, they concluded that offering patients a yoga regimen may help them regain some of their lower back function.

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